4 - (SYM 110) STEP Adaptations to Enhance Feasibility & Scalability of Intervention Delivery

In delivering STEP in real-world clinical settings in the post-COVID era, several challenges arose. We addressed them by adapting STEP to meet stakeholder needs.

The first set of challenges in our multi-site R01 on inpatient units included a severe shortage of inpatient beds that led to rapid patient discharges due to acute risk, higher acuity of remaining patients on the unit, and a dire shortage of inpatient clinical staff. This led to a need to compress sessions and deliver them quickly. To enhance feasibility and scalability of STEP, we created brief, 2-minute animated videos with condensed versions of intervention content. Videos are currently being piloted, and we are gathering preliminary feasibility data from clinicians and participants.

A second challenge was demand by clinical staff in both inpatient and outpatient settings for a more scalable version of STEP: a group intervention. We thus adapted the 4-session intervention to be delivered in group format. Sessions focused on emotion psychoeducation and using mindfulness, gratitude, and savoring to promote positive affect. Each of the latter three sessions involved experiential group exercises. We piloted this group version in an outpatient clinic with 53 young adults, ages 18 to 26, receiving psychotherapy in that clinic. Participants were primarily White (77.4%) and identified as heterosexual (57.7%) women (65.4%). Most were full-time students (58.5%) or fully employed (22.6%), and living independently (44.2%) or with family (36.5%). They were randomized in a 2:1 ratio to either STEP (n = 35) or enhanced treatment as usual (ETAU; n = 18). On average, participants attended 3 sessions (SD=1.48), with over half (56%) completing all 4, and 80% completing at least 1. Participants reported high satisfaction, with 83% rating STEP quality “good” to “excellent” and indicating that what they learned in groups “helped somewhat” to “helped a great deal.” This sample was higher-functioning than samples recruited from inpatient settings, and there were no suicides or attempts over follow-up. While there were no statistically significant changes in suicide ideation, SIQ scores decreased more dramatically in STEP (53.8 to 42.3) versus ETAU (68.5 to 59.5) from baseline to follow-up. 

Future studies will examine whether these methods for more efficient and scalable delivery can be deployed in low resource settings.